It is hard not to compare ourselves to others, particularly in a digital age where social media allows us to constantly see what others are up to. Keeping up with Jones’ now means much more than keeping up financially; popular hashtags on Instagram indicate that now we are competing with our peers on everything from what we are wearing, to what we are eating, to where we spend our free time, to how we are grooming our eyebrows (I’m not kidding #eyebrowsonfleek has over 270,000 posts of males and females showing off their brows).What toll does the constant comparison of ourselves to others via social media have on our self esteem? As research shows, not a good one. After scrolling through newsfeeds, we are left feeling unsuccessful, unloved, unattractive and boring: particularly when we how well off others depict themselves.

For examples, after scrolling through your news feed and seeing numerous beautiful, filtered vacation photos? Are you left feeling overworked, burned out, stressed and poor, thinking that if you weren’t, wouldn't you be on that fabulous vacation too?

Pictures of your friends hugging, kissing and laughing with significant others? Does it often lead you to feel lonely and unloved? Those unending photos of adorable, cherubic children? Does it trigger you to think your priorities are mixed up because you do not yet have kids?

The infamous #OOTD (Outfit of the day): This hashtag is used for photos of people (mostly women) showing off their well put together look - almost always accessorized with a pricey purse and shoes. Its easy for these images to trigger thoughts centered around I never look that polished or put together. I could never afford those labels or brands.

And then of course - food pictures, check ins at restaurants, trendy bars, photos of people having the best time ever, #yolo – do you find yourself thinking I feel lonely, unhappy, unwanted, and bored with my life that would never look so fabulous or glamorous.

And my favorite thought - everyone else seems so happy.

Stop!! Stop the negative thoughts and the self-deprecating inner monologue. This is the negative side effect of social media. While laying in bed late at night scrolling, letting our self esteem and self worth plummet, we forget that these images, check ins, hashtags and comments are only showing us a small glimmer of a person's life. And that glimmer is not necessarily an accurate perception.

Even people who project their internet image as someone who is living life "footloose and fancy free," may experience their own share of self doubt, self loathing, anxiety and sadness. We forget that it only takes a second to smile for a camera, or pose happily for a selfie – but that that one second smile does not necessarily equate to a happy life.

This video demonstrates this point, and is powerful in driving this message home. Its well worth the 2 minute watch. It tells the story of a man whose life is in shambles, and who, completely taken over by depression and loneliness, turns to Facebook to make sure everyone else thinks his life is perfect. The film dives into the dark reality of social media, the realization that the lives people create online may not be what they seem to be.While the research on the negative effects of social media of our constant connection to each other through social media is overwhelming and includes links between sites such as Facebook and feeling miserable, an overall decline in our wellbeing, anxiety, increased feelings of inadequacy, sleep problems, depression and stomachaches.

But we do not need scientific evidence to prove the point that social media feeds often makes us feel sad about ourselves as well as unfulfilled and lacking. Patients report this connection in my office all the time, and cite it as something that contributes to their depression and anxiety.

How can we limit the negative effects of social media on our own emotions and wellness? Here are some tips:

1) Understand your social media use. How much time do you spend a day on Facebook, Twitter and Snapchat? Most people grossly underestimate their frequency, and forget how often we check just to pass the time (Think: waiting for the train, riding the elevator, on line at Starbucks…) RescueTime can help. It will give you a breakdown of your internet activity at the end of the day. The awareness of how much time is spent on social media alone may be enough to change this behavior.

2) Limit scrolling time – BoundariesCreate boundaries for yourself. Maybe you need to cut down on the number of times you check your Facebook, Twitter or LinkedIn feeds. Make a pact with yourself to only check after lunch and dinner.

3) Limit scrolling time – Where else can you waste your time? Most of us will incessantly check social media throughout the day to distract ourselves, to take a break, or to pass the time. Instead of using social media, what other sites can you direct yourself to? Is there a game you can play on GameCenter? Is there a book you can read on your Kindle? Find other websites to use as a mental distraction throughout the day. Check out Mashable’s list of the 50 Websites to Waste Your Time On 4) Limit Scrolling Time – Calling in the big gunsSites like RescueTime can help limit the actual amount of time you spend on a particular site by tracking your internet use and creating alarms and limits. AntiSocial does the same thing - it will block particular social media sites for a preset amount of time.

5) Adjust who you follow - Delete and hideThere's nothing wrong with hiding, deleting or unfollowing the people who are constant triggers - either the over posters, oversharers, or juse those with overly fabulous lives that regularly makes your self esteem plummet.

6) Adjust who you follow - Make better follow choicesBy the same token, start following better, more inspiring people, places and organizations. Break up your social feed by following those who you find inspirational, motivational, interesting or funny. Like to travel? Add www.instagram.com/goodtravelyoung or www.instagram.com/muraosmannLike to laugh? Sites like https://www.facebook.com/ToMakeYouLaugh and can offer you a few giggles and a nice break from people bragging about their sunday funday. Like to workout? Try www.instagram.com/toneitupLike to be inspired? Follow https://www.facebook.com/thispageisaboutwordsLike to read? Add https://www.facebook.com/EatSleepAndReadThe list is endless. Think of your interests and hobbies and tailor your social media feeds to include those as well.

A common question my patients ask me is how to disclose to family and friends that they are experiencing depression. My patients report that family and friends typically respond in one of two ways: they are overly helpful and supportive, repeatedly asking the person, “How are you feeling?” “How are you doing?” Or, they are unsupportive and unsympathetic, “What do you have to be depressed about?” “Cant you just snap out of it?” For a person already feeling depressed, neither of these responses are particularly helpful, and can only exacerbate the sadness, loneliness and despondency that the person was already feeling. If you are experiencing depression and have decided to talk to close friends and family members about how you are feeling, it is important to take control of the situation. Others will respond based on your delivery of the information. Keep the following tips in mind: 1. Who should I tell? If you are experiencing depression, there are certain people in your life who probably have already suspected that something was going on. Maybe they noticed a change in your mood, interests or energy level. It is an easier conversation to have when the person is already aware of the fact that you are experiencing something. It is also helpful to decide who you think would be the most supportive, and talk to them first. 2. Personalize the experienceExplaining how you are affected by depression can help the person understand how you are feeling. Depression affects everyone differently. Describing your specific symptoms may convey the severity of your experience. For people who have never experienced depression, they may not understand how the symptoms manifest. Letting them know that you are not just feeling bad, but also have no energy, have lost your appetite and lost your interest in daily activities can be helpful. For example, say, “Some days I just cant get out bed,” or “I’m plagued by negative thoughts in my head all day.” 3. Share your treatment strategyLet the person know what you are doing to help yourself feel better. Maybe you are attending psychotherapy, group therapy or are considering medication. The other person may be relieved to know that you have identified the symptoms and that you are actively treating them. It is a good idea to have someone who can help monitor symptoms, particularly in the event that they worsen in frequency or severity. Additionally, they may also be helpful in keeping you motivated to attend appointments. 4. Let them know how they can, and can’t, helpThis is the most important point. Let the other person know specifically what they can do that would be helpful to your treatment and recovery. Should they call you and check in? Do you need help from time to time with errands when you are feeling tired or overwhelmed? Most people forget that it is just as important to let them know what you would not find helpful. Oftentimes, my patients tell me that they do not want to be asked how they feel. Is this on your “do not do” list? Consider your phrasing carefully. You may tell the person, “please don't ask me repeatedly how I am feeling, I would rather you be available to talk to me if I reach out to you, such as when I’m feeling down.”Another patient of mine repeatedly complained that she felt like she was treated differently because of her depression diagnosis. She hated feeling like people were “walking on eggshells around her.” If this is how you feel, it is important to communicate that to family and friends. While telling someone whatnot to do may feel like an uncomfortable conversation, it is better to think of it in terms of letting the other person know exactly what you need. Remember, you chose to tell this person because you believed they would be supportive; they want to know how they can help you. 5. What if they are not supportive?There is still a very real possibility that despite your best efforts, the person you have confided in is still not supportive of your struggle. Some people will still respond with, “its all about will-power,” or “you have to focus on the positive.” This type of individual will only serve to exacerbate your sadness and add to your frustration. There are several options for next steps:- Provide some psychoeducation. Oftentimes, people are not supportive to someone’s plight with depression because they lack education. They have ill-conceived notions about the illness and outdated information; basically, their opinions are not based on psychological fact or theory. Try giving them pamphlets or informational brochures from your psychologist’s office, or print some up-to-date information about the course and treatment of depression from websites such as The American Psychological Association (www.apa.org), National institute of Mental Health (www.nihm.nih.gov) and National Alliance on Mental Illness (www.nami.org).- Realize it’s their issue, not yours. There are some people who simply cannot understand the neurobiological mechanisms of depression, and no matter what, will not be empathetic or supportive. As difficult as this may be, it is important that this does not become an additional stressor or source of frustration. Remind yourself that there may be reasons why this person cannot be there for you: are there in denial? Are they experiencing their own depressive symptoms? A difficult decision for you to make may be deciding to put distance between you for the time being, so that you can focus on your mental health and not allow any more negativity to contribute to your mood. Keep in mind that according to the Center for Disease Control and Prevention, from 2007-2010, 8% of Americans over the age of 12 were diagnosed with depression. That means there are approximately 2.5 million people who understand how you feel. Remember, there are people who will listen, who will help and who will be supportive. Reach out to your counselor or therapist if you are having a difficult time either disclosing your depression, or are uncomfortable with the outcome of the conversation.

I've had numerous patients say things to me like, "I'm sure I'm boring you," and "my life must sound so boring." Does this sound like you?

I have even had a patient discontinue therapy, supposedly because of work commitments, to come back later during a difficult time and tell me, "I stopped coming because I felt like I was boring."

Listen up! Boring is not, necessarily, a reason to stop therapy. In fact, if you feel that you are bored with your therapy sessions, it is important that you discuss this with your therapist.

Don't be embarrassed by boredomBoredom may be a sign of progression, which is a good thing. It may also mean that something isn't working quiet right and it's important that your therapist is aware of it so changes can be made.

Define boredomWhat do you mean by boredom? Are you struggling to find things to talk about? Are your presenting concerns or symptoms no longer an issue? The better you can identify what it is you are feeling, the easier it will be for the therapist to point you in the right direction.

Boredom defined: Are you stuck? Being stuck in therapy means not making an progress; the strategies and / or interventions aren't working and you may be feeling frustrated with this lack of progression. Defining boredom this way may lead to a change in approach or strategy on the part of a therapist, or sometimes, a referral to someone who is better equipped to help you. Boredom defined: Do you feel bad talking about your pain, when you are sure some people have it much worse?This may sound like a ridiculous idea to some of you, but for many, this is a real concern. Many individuals feel guilty about experiencing sadness and anxiety when there isn't anything significantly wrong in their life.

If you believe this to be true, let me remind you of a few things - - There are biological reasons why we feel anxious and depressed. Sometimes, in the absence of triggers, we experience symptoms just because of the way our brain is wired.

- Triggers are in the eye of the beholder. Something that makes me sad and depressed or anxious and worried may not seem like a big deal to anyone else, but they don't have to. Everyone is on their own journey in life, and what brings me down may be different for you. Also, the very thoughts that drive anxiety and depression are by definition, irrational. So they can't possibly, and do not have to, make sense to anyone else.

Boredom defined: Have you reached all of your therapy goals? One reason why you may feel bored in your therapy sessions is because you've already reached your therapy goals. Maybe you are no longer feeling depressed and are now better able to cope with anxiety. If so, congratulations on your accomplishment! Your therapist may help you decide if there are new or additional goals to work towards, or if therapy sessions should be moved to more of a maintenance or check-in schedule, or terminated altogether.

Boredom defined: Is there a good match between you and your therapist? The dynamic between you and your therapist is an important one. You should feel comfortable and connected. The point is to be relaxed enough to let your defenses down, and to speak openly and honestly. It is important that your therapist's approach both personally and professionally makes you feel at ease.

Personally, is he / she laid back? Genuinely empathetic? Does he / she ask insightful questions, or talk too much?

Professionally, does his / her approach to therapy make sense to you logically?

Boredom defined: Is it time to scale back (or discontinue) therapy sessions? If you have made steady progress towards your therapeutic goals, and your sessions now seem stale, it may be time to scale back the frequency in which you see your therapist. It is not uncommon to reach a maintenance phase in therapy; where you do not have much to report week to week, but still benefit from a check-in, a brush-up on skills, or from having someone hold you accountable to continue working on your goals, decreasing session frequency may be a good idea. Patients typically move from weekly to bimonthly to monthly appointments before discontinuing treatment.

As you work through this maintenance schedule, you may accomplish your therapeutic goals as well as take care of triggers, situations or environments that have caused you distress. This may be the time to consider the possibility of being finished with psychotherapy at this time.

Regardless of the reason for feeling bored or stuck in therapy, this is often a natural part of the therapeutic process. Chances are your therapist has already picked up on this, so be sure to bring up your feelings and concerns. You and your therapist can come up with a plan for action.

In my last blog post, I talked about how thought logging can be a useful tool to become familiar with the frequency and severity of your negative thought patterns. One thing that hopefully became apparent by paying attention to your thoughts is how irrational they can be. Oftentimes, patients are surprised at how illogical their beliefs are. It is not uncommon for me to hear things like "I know it is ridiculous that I thought everyone at the party was talking about me," or "of course I don’t actually think that if this doesn't work out, nothing ever will." Now that you have some self-awareness of how you think, hopefully you are able to identify the types of thoughts you are having. As I mentioned in my last post, common types of automatic negative thinking include:

What if ThinkingWhat if I go to the party and no one talks to me? What if I say something stupid? Mind Reading I know everyone is talking about me.They are all thinking I don’t belong here. Black and White Thinking If I don’t get this absolutely perfect, I will look like a complete failure. This chicken came out a little bland; I’m an absolutely terrible cook.Catastrophic Thinking I didn’t see the typo in that email, I’m so stupid. My friend cancelled plans on me; that must mean our friendship is over.Tip: Also be on the look out for key words such as always, never, should and must, as these words typically indicate a negative thought! In your daily thought log, go back and identify the thought pattern. Once you do this a number of times, you should naturally start to identify your thought pattern in the moment that occurs. Has that happened yet? If it is not happening in the moment, keep working! Continue to log your negative thoughts throughout at the end. After you identify the thought, name the type of thought. With a little practice, it will start to occur naturally on its own. Once you become aware in the moment that you are engaging in this negative pattern of thinking, you are ready for the next step.

Next Steps: #MentalHealthChallenge Step 2I want you to actually challenge the negative thought. Go head to head with the thought by confronting it. Ask yourself questions to help disprove it, or at the very least, cast doubt on what the thought is telling you is true. I bet she's talking about my sweater. Thought: Mind Reading Challenge: Ask yourself questions like: how do I know this is true? What is the evidence? What is another possible topic she is thinking or talking about?

My boss hated my report. I'm never going to get ahead in my career. Thought: Catastrophizing, Black and white thinking Challenge: What is the evidence that he hated the report? Does one report undo all of the good work and positive feedback I have received throughout the rest of my career? What can I do better next time?

Good ways to challenge negative thoughts are to ask yourself questions such as:-What is the evidence that this is true?-What is another possible explanation? -Does it actually matter?-What would I tell my best friend if they were having this thought?-What is the worst possible outcome? Can I handle it?Here is a recap of the process1) Self-awareness of the presence of negative thoughts2) Identify the type of negative thought3) Challenge the negative thought

The goal is for this process to begin to happen automatically; ideally before you are even aware of the presence of the negative thought, but at the very least, before the negative thought has an opportunity to affect your mood.

Here is a sample thought log that you can use to help log this process. Keep writing and logging until you find yourself challenging thoughts in the moment.

The journey towards mental wellbeing is a long one, with many peaks and valleys. Most people can use a mental health brush up. Its a new year - time for a healthier outlook, a healthier perspective and an overall healthy, positive you. When keeping up with your resolutions, and your goals to brush up/enhance your gym routine, and enhance your diet, don't forget to include a mental health check-in!

Join us for Head to Toe's first mental health challenge - together, let's make sure you face each day empowered and positive, with minimal anxiety and sadness.

Everyday I see patients who report symptoms of depression: sadness, low self-esteem, low drive and lack of motivation. When asked for triggers - life events or situations that are providing a reasonable explanation for these symptoms, many patients can not point to anything of significance.

There are several possibilities here, but the one I would like to draw your attention to is the role you play in breeding your own depression. More specifically, how you bully yourself with nothing but your own thoughts.

Imagine this: after standing in a long line at Starbucks, you finally grab your specialty coffee and go. Halfway down the block and 2 sips later, you realize the barista got your order wrong. Now stop right there - what thought was just triggered?

For some people, the thought would be a few choice words and they would go on about their day. For others, the thoughts become much more cynical:

Or course they got MY order wrong.Nothing ever goes right for me.No one cares about what I want.

The simple thought nothing ever goes right for me becomes a breeding ground for more negativity. From a simple mistake on your coffee order, your brain begins searching for more evidence to further prove this point - and I missed the train this morning, and my boss isn't going to like the report I did. That the one negative thought about mistaken coffee starts as a snowflake, escalates into a snowball, and before you know it, develops into a complete avalanche of negative, self-deprecating thoughts. My question for you then is this: how can you possibly be in a positive mood if so many negative thoughts are running through your head?

What I have learned through counseling, is that the vast majority of people are either not at all aware of their negative thoughts, or have a very distorted view of the frequency and degree of negativity that they think.

Gaining awareness of this thinking problem is a key step to correcting it. This blog is the first step in a blog series of how changing your thinking, and thus, restructuring your cognitive habits, can lead to improved mood.

Why is this important? Think about the Starbucks example, if the thoughts going through your mind range from negativity about being neglecting at Starbucks, to failing at work - where else do the thoughts go? If the avalanche continues, it is very likely that the negative thoughts will spread to misperceptions about your abilities, skills, accomplishments and experiences.

Now stop here for a second. With all of these negative thoughts in your head, what kind of mood are you likely to be in? You are probably not light-hearted and laughing. It is much more likely that you literally, thought yourself into sadness.

Consider an additional outcome. After thinking these negative thoughts, you get back to work. You sit at your desk, frustration, sad and feeling defeated (after all, you did just tell yourself everything in your life is awful!) How motivated will you be to get your work done? Now, your behavior will be affected. You might have a lack of motivation, lack of drive. You tell yourself that you don't really care about getting this project completed. At the end of the day, when you realize you haven't accomplished anything, how are you left feeling?

This cycle of thoughts - feelings and behaviors looks like this diagram below. The field of cognitive behavioral therapy argues that this cyclic pattern can breed anxiety and depression.

So let's get things under control. First things first: How to become more aware of your automatic negative thoughts

The Mental Health Challenge: Thought LoggingThe idea here is to look for patterns in your thinking. The best way to do this is to actually write your thoughts down. Whenever you find yourself in a negative mood: angry, sad, frustrated, feeling guilty etc, make a note of what you were doing, what emotion was triggered, and the corresponding thought.

For example:Behavior: Meeting at work to go over presentation; Received negative feedback from bossEmotion: Frustration, sadness, disappointmentThought: I can't do anything right; I'm never going to get ahead in my career

Behavior: Walking back to my desk from the bathroom; Coworkers talking in whispers.Emotion: AngerThought: Why are they talking about me? They noticed my pants are a little too tight.

Can't remember to log your thoughts when you are in a bad mood? Set an alarm on your phone for lunch time, and right before bed. Try to log as many moods and corresponding thoughts as you can remember. Hopefully, the more you do this, the easier it becomes to remember in the moment throughout the day.

JournalingJournaling is a great mental health exercise because of its inherent, cathartic nature. It can also be used to make thought logging a little easier. If you find yourself in a negative mood but are struggling to identify that one particular triggering thought, try journaling. Without putting too much pressure on yourself, just try writing about the event, your thoughts and feelings in that moment. Just let the words flow. Don't know what to write in the moment? Start writing: I don't know what to write, I am doing this as a mental health challenge exercise. Let your natural stream of consciousness take over from there.

When you are finished, go back and see if you can pick out the negative thoughts.

AnalysisYou have your log so now what?After a few days of logging, start to look for triggers.

Are there any triggers that are repetitive that seem to come up numerous times? One client recently realized through thought logging that her mother's overall pessimistic mood was a significant trigger for her own negative self-deprecating thoughts.

Are the triggers situational, or environmental? Are the majority of your automatic negative thoughts occurring at the workplace, or during your commute?

Look for thought patternsAutomatic negative thoughts are referred to as cognitive distortions. People tend to think in typical cognitive distortions, or patterns. What themes can you pick up on? Here are some of the more common:Catastrophizing, or blowing things out of proportion Black or White (or all or nothing thinking), thinking that things can only possibly be this way or that way, with no additional options or room for compromiseWhat if Thinking, or thinking through all of the possible outcomes: What if this happens... What if that happensMind Reading, or Personalization, assuming you know, for a fact, what other people are thinking."Shoulds" or "Musts", I should be more successful by nowFortune Telling or predicting the future

Can you label each negative thought with its correct distortion name? The key here is to increase self-awareness. Continue logging, recording your negative thoughts and labeling the type of distortion each is until you are aware in the moment that it is happening.

Behavior: You receive bad feedback on a group project. Thought: I'm never going to get ahead. Label: Fortune-Telling: Based on the feedback you received about your work, you are predicting that you will never get ahead in your career.

I'm interested in hearing what you have become more self-aware of. Are you realizing how negative your thoughts can? Are you surprised at how frequently these types of thoughts pop up? Does the presence of repetitive triggers shock you?

Share your findings and reactions to the though logging exercise at #MentalHealthChallenge. Once you develop awareness of your automatic negative thought process, you may already see a decrease in the frequency of its occurrence. In fact, being aware that some of your thoughts are simply thoughts or exaggerates and not fact may already lead to slight improvements in mood! Next blog post we'll talk about how to challenge the negative thought so it lessens its impact on your emotional state that you don't believe it's negative message!

You know the drill – every New Years Day and Memorial Day weekend you are motivated and excited to hit the gym. You make a workout plan and tell yourself that you are committed to going every day, that this time “it will be different.” You start off great – eating low calorie, nutritious meals and fitting in good workouts. After a few weeks, you find yourself making excuses. “I’m so tired,” “I have so much to do,” “I’ll go tomorrow.” Tomorrow turns into the next day, and then the next and before you know it, you cannot remember the last time you went to the gym. What happens to all of that motivation? And how can you keep it going so that you see results? Lack of motivation and dedication to a workout plan significantly impacts results. It is impossible to lose weight, tone or build muscle without sticking to a structured workout regime. The question is, how do you maintain motivation in order to see results? Here are some tips. 1. Have a gym buddy This one is painfully obvious. Having a gym buddy holds you responsible because it forces you to answer to someone when you want to skip working out because it’s raining or because you had a really bad day. Having a partner can help keep you on track. Spice up the relationship by adding a little work out competition: race each other on the treadmill or make a bet as to who can lose 5 pounds first. Competition is great fuel for motivation! A small caveat: make sure your gym buddy has similar fitness goals and is equally committed to obtaining those goals for maximum effectiveness. A gym buddy who has more excuses than you for not working out is not going to be too helpful. 2. Set small goals Set smaller, obtainable goals as you work towards your overall goal. Setting small, training goals helps create a sense of accomplishment that will encourage you to keep going.3. Get “fitspo” (Fitspo means fit inspiration)

Keep yourself inspired. Years ago, for fitness inspiration, people cut out pictures of models from magazines and taped them to the refrigerator. Now, Instagram and pinterest are great resources for motivational sayings, before and after photos of other people's weight loss journeys, meal plans, recipes and creative workout routines. Follow several so that they regularly come up on your newsfeed. Use blogluvin to follow health and wellness blogs (follow us too!) The more you engross yourself in the healthy lifestyle, the more inspired you will be.4. Meal plan The saying "abs are made in the kitchen," is 100% correct. Many fitness experts argue that what you eat is more important than how far you can run or how many reps you can do. The problem is, it is not easy to eat healthy on the run. There are very few genuinely healthy fast food or vending machine options. So what's the answer? Meal plan and meal prep. Plan your meals out for the week – including breakfast, lunch, dinner and even your between-meal snacks. By planning out your meals for the week, you are in complete control of portion size and caloric intake. It is also helpful to prep your food for the week so that you never are too tired to cook, procrastinate or run out of time. Set some time on Sundays to prepare food for the week, divide it up into containers, and then grab and go.5. Be narcissistic Take pictures of yourself to measure your progress. Don’t be afraid to take your clothes off for these photos, you want to be able to see how you are progressing. Worried about someone getting their hands on the photos? There are a number of free apps that will keep your private photos private and require a password to access. My Media is one we like. 6. Reward yourself The psychological concept of positive reinforcement states that we are more likely to repeat behaviors that lead to positive outcomes. Use this to your benefit at the gym: do your workout, and then reward yourself – not with cake - but with a manicure on the way home or with an extra good protein shake at the gym.7. Maintain overall health Work on committing to and maintaining overall health so that the benefits of a healthy lifestyle are that much more apparent. Eat better, sleep better and watch your alcohol intake. Most people start to lose motivation for the gym because they do not see results. A good fitness plan combined with a good overall lifestyle should have you start looking and feeling better pretty quickly - and once you start seeing and feeling differently, intrinsic motivation to maintain it will increase.

A recurring conversation that I find myself having with most patients, regardless of what their symptoms are, is making sure that they have the “mental health trifecta”: a good support system of friends and family, an exercise regime and hobbies or activities that they enjoy. Recently, I find myself adding a fourth tenant, and that is, an Internet connection. There are a slew of websites and applications that can be used to help encourage, improve and maintain mental health. Everyone can benefit from a mental health boost, even those of us who are just having a bad day, or going through a rough patch and may be experiencing emotional symptoms at a subclinical level. For those experiencing symptoms at a clinical, or diagnosable level, websites and applications such as those can help maintain effective coping strategies, help promote mental wellness between appointments, and can also be used as a tool to help facilitate psychotherapy. The links provided below are sites that I have heard good feedback on from a variety of both friends and patients. It is important to note that the effectiveness of coping strategies varies – both by individual preference, but also situationally; what works in one context may not necessarily work in the next. That is why it is important to build a toolbox of useful interventions that you can pull from when you need to. Anxiety As I discussed in a previous blogpost, the best treatment for anxiety is deep breathing, mediation and relaxation. There are plenty of websites that have guided relaxations that you can listen to. Guided relaxations are similar to meditations, in that you are instructed to close your eyes, and take long, slow, deep breaths. The point is to focus on your breathing so that it is steady and slow. Meditation typically instructs us to clear our minds and focus on nothing but our breath; this is difficult for someone with anxiety, because our minds tend to be racing with thoughts, and it is difficult to simply “stop thinking.” The guided relaxations give us something to listen to. Sometimes it is specific direction about how to breath, and sometimes it is a visual image to focus on, such as a relaxing beach scene. Here are some of my favorite links: Headspace – The Headspace app is a great mindfulness and meditation app that offers free 10-day meditation programs, with guided meditations in 10 minutes or less. UCLA offers great links for a variety of breathing exercises:http://marc.ucla.edu/body.cfm?id=22 If you tend to be stressed and overwhelmed at work, here are two options for quick anxiety-reducers:www.calm.com - One of my absolute favorite websites. Pick your preferred nature scene (such as ocean waves or a dripping rain), and your computer screen is transformed into a relaxing oasis. Simply watch while listening to relaxing sounds, or do a guided relaxation in as little as two minutes. There is also a coordinating app available for iphone and Android. site to www.calm.com, this site presents a relaxing ocean scene paired with the subtle sound of crashing waves. The kicker here is that a timer counts down 2 minutes – encouraging you to take a small break from your day and relax. If you try to move the mouse or keyboard before the timer is up, the screen flashes FAIL. Your screen doesn't lock and you can easily leave the page, just as you would any other website. The idea is that 2 minutes it not a long time, but it is long enough to take a breather and decompress. Mindfulnesshttp://www.donothingfor2minutes.com - A similar I previously dedicated an entire blog post to the art of mindfulness, but it is worthwhile to reiterate the helpful sites here. The aforementioned app, Headspace, is a great introduction to the benefits of mindfulness. Additionally:Mindfulness of Your Hand is a good guided mindfulness tool. Mindfulness Daily provides mindfulness-based meditations that can be used daily. Once installed on your phone, the app will prompt you with reminders throughout the day to check in with yourself and your surroundings. Insomnia Are you having difficulty falling asleep? Often anxiety and insomnia go hand and hand, and ruminating or recurrent thoughts keep us from being able to fall asleep. A relaxation geared toward falling asleep can be helpful. The UCLA site has a great relaxation for sleep:http://marc.ucla.edu/body.cfm?id=22 Additionally, soft sounds or relaxing noises can be helpful, as it gives us something to listen to, and hopefully distract us from the worries of the day, or the to-do list we are going over and over in preparing for the next day. Relax Melodiesis a great, free app with over 50 soothing sounds, including thunderstorms, melting river, wind in leaves, and frogs. The best part is that you can set a timer so that the app will turn off on its own – hopefully after you have already fallen asleep. (The fireplace is my favorite).Muscle Tension When experiencing anxiety, it is not uncommon to feel the negative tension throughout your body, particularly in your neck, shoulders and head. A good way to relax those muscles and release the tension is through a progressive muscle relaxation.Depression When talking about sadness and depression, I constantly ask questions about underlying thoughts. Thoughts drive our emotions and our moods. One of the most helpful homework assignments that I use for sadness is a thought log, asking people to record their thoughts whenever they find themselves in a negative mood, whether sad, angry or frustrated. After a few days of thought tracking, you can then go back and look for patterns in the thoughts: do you tend to catastrophize? Do you always think in terms of black and white, with no middle ground? Self-awareness of these types of thought patterns is the first step in changing your thoughts, and therefore, controlling your mood. Thought Diary Pro is an app designed to help you keep track of your mood and corresponding thoughts. Moody Me is an app that helps you track your daily mood and activity, so that you can start making links between triggers and emotions. The app also allows you to take pictures of things that make you happy, so that you can play them back when feeling down.

A number of patients come in to my office with fears and worries related to possible future events. What if this happened, or what about this possibility. While worrying and thinking about the future can be adaptive and useful as it helps us to plan and prepare, a fine line exists between the utility of worrying and the point at which it becomes maladaptive. Maladaptive worries trigger anxiety, and sometimes also depression in many people. We can physically respond to this anxiety by becoming tense, over or under eating, having trouble breathing, difficulty sleeping or sleeping too much, begin to feel sick or in some cases, experience a panic attack. Many health professionals and articles you read related to anxiety focus on the physical ramifications of anxiety and offer strategies such as exercise and deep breathing as effective coping mechanisms. However there is another side effect of anxiety that often gets overlooked: if you are constantly concerned about what can happen in the future, are you fully appreciating what is happening right now? Are you present in the moment? Are you enjoying experiences with family and friends? What are you missing out on by not being fully aware in the moment that you are in? Coping with the anxiety and allowing yourself to fully enjoy the present moment will allow you to be a better parent, partner, employee and friend. But that is easier said then done. How do you stay in the moment when your mind is racing with thoughts about other things? What if I can’t pay my bills on time? What if the people at the party think I don’t belong there? I have so many things to do tomorrow…. This is where the concept of mindfulness comes in. The idea of mindfulness has its root in meditation and involves "maintaining a moment-by-moment awareness of our thoughts, feelings, bodily sensations, and surrounding environment." Here’s a simple, classic example of mindfulness: think about how long it would take you to eat a single raisin, kernel of popcorn or cherry tomato. Most people would never only eat a single item of these foods, and if they did, it would take mere seconds to chew and swallow. The practice of mindfulness is often taught while eating a single raisin, where the activity is drawn out as long as possible. The individual may be instructed to look at the ridges of the raisin, and how the color of the skin differs as the light hits it in different places. The individual may taste the skin of the raisin before biting into it. Once bitten, the person would be asked to describe the differences between the taste and texture of the raisin’s skin versus the taste and texture of the inside. What are the benefits of mindfulness? Mindfulness has been shown to have a number of positive benefits on emotional and physical health, including lowering stress and anxiety levels, pain management, depressive symptoms and insomnia. Using mindfulness strategies while eating have also been linked to overall better eating habits and weight loss. This Huffington Post article summarizes 20 scientific studies that have found positive benefits of practicing mindfulness. How can you put mindfulness to use? If you are so stressed about tomorrow’s to-do list, are you enjoying the relaxing shower that you are taking? Try thinking about the smell of the soap and the feel of the warm water on your skin. If you are worried about how you will be perceived in an upcoming social situation, are you enjoying playing with your dog? Try thinking about the feel of the dog’s fur or the texture of his nose as he rubs it against you. Other ways to practice: while washing dishes, eating lunch, taking a walk, dusting – any activity will work. Try to engage as many senses as you can. While practicing mindfulness, it is normal for your mind to wander. Do not judge the interrupting thoughts, just slowly bring your mind back to your practice and start again. Be sure you are breathing slowly and deeply. Below are links to scripts to help you get your mindfulness practice started: The Raisin Walking Mindfully Mindfully Eating a Piece of Chocolate Mindfulness of Your Hand (audio, guided meditation)

While on social media last week, (Flipboard to be exact), I came across an article on a man named Horace Greasley. He was a British solider during World War 2. He was captured and imprisoned for almost three years in a Prisoner of War camp in Poland, an annex of Auschwitz. During this time, he began dating a German woman named Rosa, who was working as a translator in a marble quarry labor camp and hiding her Jewish descent from the Nazis. Horace removed wooden bars from his cell window and crawled under wire fence in order to sneak out of the camp 200 times to continue his secret affair with Rosa. Rosa would then help him to sneak in food and equipment for himself and the other men. The couple were separated when the war ended. Rosa became pregnant and died in childbirth. They were never reunited. Horace eventually married and moved to Spain. In 2008, Mr Greasley’s moving story was turned into a book called Do the Birds Still Sing in Hell? There are now reports that Hollywood stars Robert Pattinson and Alex Pettyfer have been lined up to play him in a film. Clearly, Horace put his life – and most likely Rosa’s as well – in danger a significant number of times. He certainly would have been killed, if not tortured, had his escapes in and out of the concentration camps been discovered. Why, then, would he continue to do it? What is it about being in love that makes us make bad decisions? Are we truly, crazy in love? The literature on romantic relationships shows that our brains do in fact react differently when we are in lust and in love. We get high, and (disclaimer – here’s a bad joke) addicted to love Researchers have found that the specific areas of the brain that are involved in attraction are the same areas of the brain association with addiction cravings, specifically the structures linked to cocaine craving and addiction. These structures utilize the neurotransmitter dopamine, and are also associated with reward and motivation. It is believed that this helps to explain why when rejected, heartbroken lovers turn to behaviors such as stalking, homicide and suicide.Our hormones go haywire The neurotransmitter dopamine has already been mentioned as being related to reward and motivation. Dopamine enhances feelings of euphoria and pleasure, which is why we like being in love, which makes break-ups and heartbreaks – and an absence of these positive feelings - so difficult to get over. Levels of the neurotransmitter serotonin decrease when we are in love, causing us to feel anxious and jittery. Levels of the hormone, adrenaline, increase, leading to sweaty palms, a racing heart and dry mouth in the presence of someone we love. We can't feel pain The nucleus accumbens is the region of the brain that is activated by drugs such as opioids and cocaine. When these drugs are used, this region helps the individual to feel less pain. This same structure is activated when in love, yielding the same analgesic effects. Other research has supported this claim by showing that people report being in less pain while looking at a photo of a loved one, or holding a loved one’s hand. The authors of this particularly study quote that this finding explains “why a mother can apparently give instant comfort to a poorly child by "kissing it better".Our brains stop working The two proceeding paragraphs discuss brain structures that become activated when we are in love; research also shows that several areas of the brain become deactivated and shut down when you are looking at or thinking about a love interest. Certain areas of the brain are believed to deactivate, most likely for biological purposes. According to the authors of this article, individuals are more likely to mate and reproductive if the area of the brain controlling judgment is temporarily suspended. Additionally, individuals are more likely to feel that “everything is right in the world” and that “nothing can go wrong” when they are in love, as the areas in the brain related to fear and negative emotions also tend to be inactive.We can’t focusResearch shows that our ability to concentrate and focus on everyday tasks, such as work and schools, becomes significantly impaired when we are in love. Men take risks, and women love them for it Research shows that men are willing to engage in risk-taking behavior when a potential love interest is involved. The authors of this study believe that men’s risk-taking behavior is related to men’s evolutionary needs to attract a mate, and that even behaviors seemingly unrelated to love, such as reckless driving, are viewed as enhancers to their reputation, and as such, enhance their ability to attract a mate. The same has not been found for women, however, it was found that women are more attracted to the men engaging in risky behaviors. We have a preference for the color red Studies have shown that the color red enhances a woman’s attractiveness. In one study, men were asked to judge the sexual attractiveness of both a young (age 24) and older (age 48) woman standing in front of a white or red background. The background color had not effect on perceived sexual attractiveness for the older woman, but the younger woman standing in front of a red background was viewed as being significantly more sexually attractive than younger woman standing in front of the white background. Other studies support this finding, claiming that when a woman wears a red shirt – as compared to green, blue or white – men perceive her as being more attractive, as well as having more sexual interest. See the picture below to see how various parts of the brain are affected by love:

You may have heard of the psychiatric diagnosis of Oppositional Defiant Disorder, or ODD. It is a quite common diagnosis– in fact, it affects between 2-18% of all children under the age of 18. What are the Symptoms of ODD? According to the diagnostic criteria outlined in the Diagnosis and Statistical Manual - 5 (DSM-5), ODD is characterized by a repeating pattern of defiant, disobedient, hostile and negative behavior towards adults. Children show 4 of the following behaviors, which exhibitclinically significant impairment in social, academic, or occupational functioning: - Often loses temper - Often argues with adults - Often actively defies or refuses to comply with requests or rules - Often deliberately annoys people - Often blames others for his/her mistakes - Is often touchy or easily annoyed by others - Is often angry and resentful - Is often spiteful and vindictive Symptoms typically are observed both in home and at school. In school, these children are described as typically challenging class rules, swearing, refusing to do assignments, arguing with other students, and being socially exploitive. The manipulation, testing the limits and constant arguing between the student and the teacher, and / or the student and his peers creates a stressful environment. Children with ODD thrive on anger, conflict and aggression. They are quick to notice how others respond to negativity, and use these responses to their advantage in social interactions. What causes ODD? The exact causes of ODD are unknown, however, experts agree that there are a number of biological, genetic and environmental factors. Children can be diagnosed as young as preschool age. During puberty, more boys than girls are diagnosed; at post-pubescent ages, the diagnosis tends to be about the same between the genders. ODD has high co-morbidity rates with a number of other psychological disorders. 50-65% of children with ODD are also diagnosed with Attention Deficit Hyperactivity Disorder (ADHD); 35% also have a mood disorder, such as Major Depressive Disorder or Bipolar Disorder; and 15% also have a personality disorder. Learning disabilities, Conduct Disorder, Tourette’s Syndrome, and Obsessive-Compulsive Disorder are also common in children with ODD. Experts agree that many of the symptoms of these disorders must share common, underlying neurobiological mechanisms. How do children with ODD think? As mentioned above, children with ODD thrive on conflict and negativity. They typically are winners in escalating arguments, as they will not back down. They believe that they should be respected and that they can defeat authority figures. They fail to learn from experiences, and have a persistent drive to feel “tough” or seek revenge. Lastly, they blame others for their misbehavior. What interventions should be used with children with ODD? Children with ODD typically have poor relationships with peers and adults. Anything that can be done to improve these relationships and create more positive interpersonal interactions is a good first step. Other helpful strategies include: - Give Choices Children with ODD like to feel as though they are in control. Given them a choice between two options (would you prefer chicken or vegetables for dinner?) allows them to maintain the feeling that they are in a position of authority. - Don’t use the word “no” Again, children with ODD thrive on negativity and will not shy away from an argument. Being told “no” will automatically make them defensive, because they will interpret it as not being in control. Common reactions to feeling not in control include verbal and behavioral outbursts. Parents and educators should try to use words such as “avoid,” “escape,” and “redirect.” Similarly, avoid power struggles and raising your voice. Try to react and respond calmly. - Figure out the purpose of the defiant behavior Does the child need anger management? Social skills training? Anxiety coping techniques? Determining what is driving the negative behavior and correcting for it can lead to positive emotional and behavioral changes. A mental health professional can help with many of these skillsets. - Avoid punishment when appropriate This sounds counterintuitive. Research shows that children respond more to being rewarded for compliant behavior rather than punished for defiant behavior. Obviously, any behaviors that are dangerous or inappropriate should be punished. However, negative behaviors that can be ignored, should be, and positive behaviors should instead be reinforced. So for example, ignore curse words but reward the child when he uses a slang, yet appropriate word instead. Lastly, a mental health professional can help teach you and your child behavioral management techniques to help manage and improve defiant behavior. References: Pierangelo, R. & Giuliani, G. (2008). Classroom Management for Students with Emotional and Behavioral Disorders. Corwin Press: Thousand Oaks, CA.